What follows is information designed to prepare a person to take a tour. It details what to look for, what to look at, and assists in recognizing the essential indicators of both good and poor nursing homes.

The questions are designed to give as much information as possible about the home, its services, programs and procedures. Some of the answers will reveal more about the quality of life and patient care in a home than others. These questions are self-explanatory. In other cases, however, there are no real right or wrong answers.

Use the information collected primarily as a tool to compare homes. Use it also as a means to match the kind of care offered by the home to what is important to you and the future resident.

Remember: A nursing home can never be "home", but a good facility will try to be as much like home as possible. Observe what has been done to make the facility feel like a "home".

The entire facility should be seen. Be sure to see all of the resident living areas. Health needs and physical abilities can change in time. The possibility that a resident might have to change living areas should be considered. It is important to ask whether a marked change in physical condition would require a transfer to another part of the facility or another facility altogether. If so, how would this transfer be made?

1. Observe the Building and Grounds

It is not always wise to judge a facility by the way it looks from the outside. However, from the largest and most modern nursing home to the smallest older facility, the upkeep of the grounds can offer a hint about the care provided inside.

• The outside condition of the building appears to be kept up.
• Are the grounds well kept?
• Where possible, do residents make use of the outside area?
• Does the location of the facility encourage visits at night?
• Is the home near a bus stop? Are there other means of transportation available to the residents?

2. The Lobby

In many homes, the reception area is used as a lounge by some residents.

• Is it "inviting"... comfortably furnished, plants, pictures and other warm touches?
• Is it being used by the residents? Can it be used by the residents?

3. The Residents

Throughout the tour, always observe the residents. The residents are the best indicators of the quality of care provided in the facility. Use the following criteria in evaluating their condition. If you question what you see, ask for an explanation.

• Are residents up, dressed, clean and well-groomed (hair combed, clothes clean, fingernails clean, men shaved)?
• Is there "activity" and evidence that people are involved and busy, or do residents sit and stare at walls, TV, or out windows?

4. Hallways and Stairs

• Are all halls and stairs well-lit and clean? Are stairways clearly marked?
• Are they free of obstacles such as cleaning equipment, chairs and laundry carts (except when in use)?
• Is there a disaster plan posted? Are drills held regularly?
• Are floors clean and non-slippery?
• Are seasonal or holiday decorations evident if appropriate?
• Is there an obvious odor? (Strong urine and body odors may indicate poor nursing care or poor housekeeping. Heavy "air fresheners," deodorants, and other temporary chemical cover-ups may be "substitutes" for conscientious care and maintenance.)

• In which area of the home would your new resident be assigned a room?
• Are rooms attractive, cheerful, clean and well-lit?
• How many residents share a room? Rooms should have no more than four beds, at least three feet apart.
• Is there a bedside stand, reading light, chest of drawers and at least one comfortable chair for each resident?
• Is closet space sufficient? Is additional storage space available if needed?
• Are the rooms air-conditioned?
• Are beds easy to reach? Is there room to maneuver a wheelchair easily?
• Are residents allowed to bring some of their own furniture, i.e., a favorite footstool, chair, or TV set to the home?
• Can they hang pictures on the walls?
• Have residents personalized their rooms?
• Are provisions made for privacy (i.e., cubicle curtains around each bed?)
• Do doors or walls have name plates indicating who resides in each room?

• How many residents share a bathroom? (Facilities licensed before 1974 must have at least one toilet for every eight beds. Newer facilities must have one for every four beds.)
• Do bathrooms have firmly attached handgrips or rails near all toilet and bathing areas?
• Is there a call button near the toilet?
• If bathrooms are without showers or tubs, ask to see the shower or tub room.
• Ask when and how often residents receive baths.

• How many lounge areas are available for residents? (There must be at least one such area.)
• Does there seen to be sufficient space for visitors, conversation, TV watching?
• Are lounges clean, comfortably furnished and generally pleasant?
• Do these areas have other uses? (Many lounge areas double as dining or activity areas. Although there is nothing wrong with multipurpose rooms, access to the area can be limited for residents during certain hours. In addition, cleanliness might be affected by other activities.)
• Are there nonsmoking public areas?
• When and where are residents permitted to smoke?

A good activity program is more than a weekly bingo game and periodic craft sessions. A well-rounded program should be designed to meet the needs of all residents--regardless of physical or mental limitations. Take a careful look at the activity program!

• Are there special activity rooms or areas?
• Are activity calendars posted? If not, ask for a complete breakdown of regularly scheduled daily activities and upcoming events and ask why the calendar isn't posted.
• Do the activities include a variety of interests (i.e. birthday parties, holiday parties, special events, clubs, field trips, games, hobbies, craft sessions, exercises)?
• Do residents participate in planning activities?
• Are activities planned for room-bound or bedridden residents?
• Is there a resident newspaper? Are residents encouraged to contribute or take part in its production?
• Is there a resident "store"?
• Does the home have volunteers? What do they do?
• Are arrangements made for residents to practice religious beliefs?
• Is there a resident council? How active is it? What functions does it perform?
• Is there a Family Support Group or Council?

• Is there a variety of equipment (parallel bars, stairs, whirlpool baths, walking aids, equipment for activities of daily living, weaving looms, etc.)?
• Are the rooms clean?

• Is the kitchen clean and well organized?
• Does staff handle food in a safe, sanitary manner?
• Does the staff wear hairnets?

• Is the dining area pleasant, comfortable, clean and easily accessible?
• Are residents encouraged to eat there? Is it large enough to hold the majority of residents?
• Are tables high enough for wheelchairs?

If you visit the facility during mealtime, observe the manner in which the food is served as well as the residents' general reaction to the food.

• Has the home served the same meal that is listed on the menu? Menus should be posted.
• What methods are used to keep hot foods hot and cold foods cold?
• Does the food appear appetizing? Does it smell appetizing?
• Do residents appear to be enjoying their meal, or do many leave large portions of their food untouched?
• Is there staff intervention to find out why and assist those who have not eaten?
• Are food substitutes available for those who do not like or cannot eat the food served?
• Some residents are unable to feed themselves. Are they being assisted promptly so that food is at proper temperatures?
• Are fresh fruits and vegetables served (in season) or does the facility rely solely on canned or frozen food?
• What provisions are made for residents who are ill and unable to eat in the dining room?
• Ask to purchase a meal and then sample the food.
• How often do residents eat? When are snacks offered? Do residents contribute to dietary planning?
• If food supplements are needed, when and how are they given? Can the resident select a flavor?

A nursing home staff is made up of persons possessing different skills who are responsible for everything from maintenance and housekeeping to professional nursing. All nursing home employees, regardless of their individual jobs, interact with residents in some manner during any given day. Staff and patient interrelations are critical, and much can be learned about the quality of life in the home from observations of these relationships.

• Does the nursing home admissions person appear to know the residents? Do residents appear to recognize him/her?
• Does the staff show interest in individual patients?
• Is the staff courteous?
• Is the staff attitude condescending or are residents treated with dignity and respect?
• Does the staff use childish nicknames when speaking with residents? Do they talk about residents as if they were not present (e.g., "She really doesn't understand" or "Isn't he cute?") or, as if they were children?
• Is privacy respected (e.g., knocking on doors before entering rooms; keeping cubicle curtains drawn while care is being given)?
• Are calls for assistance responded to within a reasonable amount of time?
• Is the general level of sound in halls moderate?
• Does the paging system or staff voices, etc. affect sound levels unnecessarily?

If the following questions are not covered during the tour, it is important that they be asked before leaving the facility.

• How soon does the home inform families of any changes in the resident's health or in their surroundings (change of rooms), accidents or transfer to hospital?
• Is transportation provided for trips to hospitals, medical offices or community functions? Is there a charge?
• Are podiatry and dental services available?
• What arrangements does the home have for personal laundry?
• Are beauty and barber shop services available? At what cost? How often?

Before you leave, ask to see the Nursing Home Report. This report is public information and will tell you about staff turnover and staff-patient ratios. It should also list any recent complaints against the facility. All information in the Nursing Home Report is over one year old.

For current information from the annual State inspections, call Interfaith. The information will be given over the phone.

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